National Transportation Safety Board Aviation Accident Final Report

Transcription

1 National Transportation Safety Board Aviation Accident Final Report Location: DENVER, CO Accident Number: Date & Time: 05/31/1984, 1334 MDT Registration: N7640U Aircraft: BOEING Aircraft Damage: Substantial Defining Event: Injuries: 105 None Flight Conducted Under: Part 121: Air Carrier - Scheduled Analysis BEFORE TAKEOFF, THE CREW OF N7647U (UA FLT 663) NOTED CUMULUS CLOUDS & VIRGA IN THE AREA. AT 1327, A DEHAVILLAND DASH 7 CREW RPRTD A 25 KT LOSS OF AIRSPEED, BUT SVRL OTHER ACFT THEN TOOK OFF WITHOUT RPRTG A PROBLEM. DUE TO RADIO CONJESTION,THE CAPTAIN DID NOT QUERY OTHER AIRCREWS, BUT DECIDED TO CLIMB OUT AT V2 PLUS 20. WHEN THE CONTROLLER CLEARED FLT 663 FOR TAKEOFF, HE ADVISED THE CREW OF NUMEROUS WIND SHEARS IN 3 QUADRANTS, BUT USED INCORRECT TERMINOLOGY IN ISSUING THE WIND SHEAR ALERT. DURING TAKEOFF, THE ACFT STRUCK AN ILS LOCALIZER ANTENNA, 1074 FT FROM THE DEPT END OF THE RWY, & DAMAGED THE LOWER FUSELAGE. WHEN UNABLE TO PRESSURIZE THE ACFT, THE CREW RETURNED TO THE ARPT & LANDED. AN INVESTIGATIONREVEALED THE ACFT ENCOUNTERED WIND SHEAR FROM MICROBURST ACTIVITY WHICH REACHED ITS GREATEST ACTIVITY AS FLT 663 WAS TAKING OFF. THE WIND SHEARED FROM AN 8 KT HEADWIND TO 40 TO 56 KTS OVER A 44 SEC PERIOD. THE CREW NOTED A HESITATION WHILE ACCELERATING THRU 120 KTS, THEN AT OR BEYOND VR SPEED OF APRX 141 KTS, THE ACFT MOMENTARILY LOST 20 KTS. Probable Cause and Findings The National Transportation Safety Board determines the probable cause(s) of this accident to be: Page 1 of 5

2 Findings Occurrence #1: IN FLIGHT ENCOUNTER WITH WEATHER Phase of Operation: TAKEOFF - INITIAL CLIMB Findings 1. (F) WEATHER CONDITION - RAIN 2. (F) WEATHER CONDITION - HIGH WIND 3. (F) WEATHER CONDITION - GUSTS 4. (F) WEATHER CONDITION - UNFAVORABLE WIND 5. SAFETY ADVISORY - ISSUED - PILOT OF OTHER AIRCRAFT 6. (F) RADIO COMMUNICATIONS - EXCESSIVE 7. (F) AIRPORT/FACILITIES - INADEQUATE 8. (F) WEATHER EVALUATION - INACCURATE - PILOT IN COMMAND 9. (F) INFORMATION UNCLEAR - ATC PERSONNEL(LCL/GND/CLNC) 10. (C) WEATHER CONDITION - WINDSHEAR Occurrence #2: IN FLIGHT COLLISION WITH OBJECT Phase of Operation: TAKEOFF - INITIAL CLIMB Findings 11. (F) OBJECT - APPROACH LIGHT/NAVAID Page 2 of 5

3 Factual Information Pilot Information Certificate: Airline Transport; Commercial Age: 46, Male Airplane Rating(s): Multi-engine Land Seat Occupied: Left Other Aircraft Rating(s): Restraint Used: Seatbelt, Shoulder harness Instrument Rating(s): Airplane Second Pilot Present: No Instructor Rating(s): None Toxicology Performed: No Medical Certification: Occupational Pilot: None Valid Medical--no waivers/lim. Last Medical Exam: 03/06/1984 Last Flight Review or Equivalent: Flight Time: hours (Total, all aircraft), 8000 hours (Total, this make and model), 69 hours (Last 30 days, all aircraft), 6 hours (Last 24 hours, all aircraft) Aircraft and Owner/Operator Information Aircraft Manufacturer: BOEING Registration: N7640U Model/Series: Aircraft Category: Airplane Year of Manufacture: Amateur Built: No Airworthiness Certificate: Transport Serial Number: Landing Gear Type: Retractable - Tricycle Seats: 144 Date/Type of Last Inspection: Continuous Airworthiness Certified Max Gross Wt.: lbs Time Since Last Inspection: 0 Hours Engines: 3 Turbo Fan Airframe Total Time: Engine Manufacturer: P&W ELT: Not installed Engine Model/Series: JT8D-7B Registered Owner: UNITED AIRLINES Rated Power: lbs Operator: UNITED AIRLINES Air Carrier Operating Certificate: Flag carrier (121) Operator Does Business As: Operator Designator Code: UALA Page 3 of 5

4 Meteorological Information and Flight Plan Conditions at Accident Site: Visual Conditions Condition of Light: Day Observation Facility, Elevation: DEN, 0 ft msl Observation Time: 0000 Distance from Accident Site: 0 Nautical Miles Direction from Accident Site: 0 Lowest Cloud Condition: Unknown / 8000 ft agl Temperature/Dew Point: 28 C / 4 C Lowest Ceiling: Broken / 8000 ft agl Visibility 20 Miles Wind Speed/Gusts, Direction: / 32 knots, Variable Visibility (RVR): 0 ft Altimeter Setting: 29 inches Hg Visibility (RVV): 0 Miles Precipitation and Obscuration: Departure Point: Type of Flight Plan Filed: IFR Destination: LAS VEGAS, NV (LAS) Type of Clearance: IFR Departure Time: 1333 MDT Type of Airspace: Class E Airport Information Airport: STAPLETON (DEN) Runway Surface Type: Concrete Airport Elevation: 5333 ft Runway Surface Condition: Dry Runway Used: 35L IFR Approach: Runway Length/Width: ft / 150 ft VFR Approach/Landing: Precautionary Landing Wreckage and Impact Information Crew Injuries: 7 None Aircraft Damage: Substantial Passenger Injuries: 98 None Aircraft Fire: None Ground Injuries: N/A Aircraft Explosion: None Total Injuries: 105 None Latitude, Longitude: Administrative Information Investigator In Charge (IIC): STEPHAN J CORRIE Adopted Date: 08/30/1994 Additional Participating Persons: Publish Date: Investigation Docket: NTSB accident and incident dockets serve as permanent archival information for the NTSB s investigations. Dockets released prior to June 1, 2009 are publicly available from the NTSB s Record Management Division at pubinq@ntsb.gov, or at Dockets released after this date are available at Page 4 of 5

5 The National Transportation Safety Board (NTSB), established in 1967, is an independent federal agency mandated by Congress through the Independent Safety Board Act of 1974 to investigate transportation accidents, determine the probable causes of the accidents, issue safety recommendations, study transportation safety issues, and evaluate the safety effectiveness of government agencies involved in transportation. The NTSB makes public its actions and decisions through accident reports, safety studies, special investigation reports, safety recommendations, and statistical reviews. The Independent Safety Board Act, as codified at 49 U.S.C. Section 1154(b), precludes the admission into evidence or use of any part of an NTSB report related to an incident or accident in a civil action for damages resulting from a matter mentioned in the report. Page 5 of 5